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As part of a multi-country evaluation, the SD Biosensor STANDARD Q Filariasis Antigen Test (QFAT) was compared with the Abbott Bioline Filariasis Test Strip (FTS) for assessing Wuchereria bancrofti infection prevalence and for ease of use of QFAT in field conditions in Sierra Leone. The evaluation was done in two districts, Bombali and Karene, where repeat pre-transmission assessment surveys (pre-TAS) were planned. Two rural sites, Kagbo and Makorba Yelimini which recorded high LF antigen prevalence of 4.1% and 7.7% respectively in repeat pre-TAS in 2020 were selected for the QFAT evaluation. At least 350 people ≥5 years were targeted per site for inclusion in the study by convenience sampling. Blood was collected by fingerstick; 20μl for QFAT and 75μl for FTS. The reading time for both tests was 10 minutes. For all positive or invalid results, a repeat test was performed for both tests. In total, 728 participants (5-91 years) were tested by QFAT and FTS. Four FTS and three QFAT final results were classified as indeterminate (meaning a positive result followed by a negative result) and were excluded from the analysis. The positive rate was 4.8% (17/357) and 3.5% (13/367) for FTS and 3.4% (12/359) and 4.1% (15/366) for QFAT in Kagbo and Makorba Yelimi, respectively. All participants testing positive for FTS or QFAT underwent further testing by night blood smear to detect microfilariae using microscopy. No W. bancrofti microfilariae was detected in any of the antigen positive cases. In field conditions, QFAT was easy to handle and recorded zero invalid tests compared to FTS (six invalids). The concordance between FTS and QFAT was 0.81 (Cohen's Kappa). The discrepancy found between the two tests in terms of positive tests was not statistically significant (p = 0.78). The results suggest that the QFAT is a credible W. bancrofti diagnostic test when compared to the routinely used FTS; use of either test would result in the same program decision.

Onchocerciasis control activities in Mali began in 1975 with vector larviciding carried out by the Onchocerciasis Control Programme (OCP), followed by the distribution of ivermectin from 1998 until the closure of the OCP in 2002. At that time, epidemiological evaluations, using skin snip microscopy and O-150 pool screening PCR in black flies, indicated that the disease had been largely controlled as a public health problem. Ivermectin distribution was nevertheless continued after 2002 in 34 of the 75 health districts in Mali as these were known to still be meso- or hyper-endemic for onchocerciasis. In addition, the onchocerciasis sites known to be hypo-endemic for onchocerciasis benefited from the distribution of ivermectin treatment as part of the mass drug administration (MDA) program for lymphatic filariasis. Various entomological and epidemiological evaluations have now indicated that Mali may have achieved successful interruption of onchocerciasis transmission. A series of cross-sectional surveys to update vector breeding sites throughout the endemic areas, followed by a pre-stop ivermectin mass drug administration (Pre-stop MDA) survey, were undertaken in 2019-2020. Based on breeding site findings, historical epidemiological assessments, and vector collection site maps, 18 operational transmission zones (OTZ) were delineated within which a total of 104 first line villages were selected for evaluation. Dried blood spots (DBS) samples were collected from 10,400 children (5-9 years old) from these 104 first line villages and processed for the presence of OV16 antibody using a lab-based rapid diagnostic test. Within the 544 Simulium damnosum s.l. breeding sites visited in all five endemic onchocerciasis endemic regions of Mali 18.01% (98/544) were seen to be active with the presence of at least one stage of S. damnosum. The overall prevalence of OV16 positive children was 0.45% (47/10,400). However, two hotspots were identified: 2.60% (13/500) seroprevalence in the OTZ number 5 in Kayes Region and 1.40% (7/500) in the OTZ number 1 of Sikasso Region. These data show that onchocerciasis prevalence in the five endemic regions has declined to levels that indicate that Stop-MDA surveys should be now carried out in most of the OTZ except for one in the Kayes Region. This latter site will need additional ivermectin treatment before reevaluation, and an OTZ in the Sikasso Region requires revaluation before possibly reinitiating MDA.

Background Guinea reported its first case of COVID-19 on March 12, 2020. Soon thereafter, a national state of emergency was declared, all land borders were closed, schools were shut down, and public gatherings were limited. Many health activities, including field-based activities targeting neglected tropical diseases (NTDs), were paused. The World Health Organization (WHO) issued updated guidance on the resumption of NTD field-based activities on July 27, 2020. In response, the Guinea Ministry of Health (MoH) and its partners planned and resumed mass drug administration (MDA) in mid-August to September 2020 in 19 health districts. Methodology/principal findings A risk-benefit assessment was conducted to identify potential risks associated with the MDA in the COVID-19 context. Following this assessment, a risk mitigation plan with barrier measures was developed to guide MDA implementation. These measures included COVID-19 testing for all national staff leaving Conakry, mask wearing, social distancing of two meters, and hand washing/sanitizing. A checklist was developed and used to monitor compliance to risk mitigation measures. Data on adherence to risk mitigation measures were collected electronically during the MDA. A total of 120 checklists, representing 120 community drug distributor (CDD) teams (two CDDs per team) and 120 households, were completed. Results indicated that washing or disinfecting hands was practiced by 68.3% of CDD teams, compared to 45.0% among households. Face masks to cover the mouth and nose were worn by 79.2% of CDD teams, while this was low among households (23.3%). In 87.5% of households, participants did not touch the dose pole and in 88.3% of CDD teams, CDDs did not touch the hands of the participants while giving the drugs. A large majority of CDD teams (94.2%) and household members (94.2%) were willing to participate in the MDA despite the pandemic. The epidemiological coverage was [greater than or equal to]65% for lymphatic filariasis, onchocerciasis and soil-transmitted helminths in 10 out of 19 HDs and [greater than or equal to]75% for schistosomiasis for school-aged children in 7 out of 11 HDs. Conclusions/significance Guinea was one of the first countries in Africa to resume MDA activities during the COVID-19 pandemic without causing an observed increase of transmission. The development of a risk mitigation plan and a method to monitor adherence to barrier measures was critical to this unprecedented effort. The rapid incorporation of COVID-19 barrier measures and their acceptance by CDDs and household members demonstrated both the adaptability of the National NTD Program to respond to emerging issues and the commitment of the MoH to implement NTD programs.

IntroductionMali was endemic for soil-transmitted helminthiasis (STH), mainly hookworms in the southern regions. Following baseline mapping, mass drug administration (MDA) for STH was integrated with MDA for schistosomiasis for school-aged children (SAC) or lymphatic filariasis (LF) for populations aged five and older and vitamin A supplementation for preschool children. Epidemiological evaluations were conducted to assess progress towards eliminating STH as a public health problem.MethodsCross-sectional studies were conducted in schools in 2004–2005 at baseline and in 2014–2019 for integrated evaluation with either schistosomiasis assessments or LF transmission assessment surveys (TAS). Children aged 7–14 years (6–7 years in TAS-STH surveys) were selected through systematic random sampling, and stool samples from selected children were examined using the Kato–Katz method for the eggs of any species of STH. The prevalence of infection and the prevalence of moderate-intensity and heavy-intensity (MHI) infections were calculated.ResultsA total of 13 769 SAC were examined at baseline in 2004–2005, with an overall STH prevalence of 6.3% (95% CI 5.9% to 6.7%). Overall STH prevalence was the highest in Sikasso (22.9%), followed by Segou (9.4%). The prevalence of MHI infections ranged from 0% to 9.0% among the survey sites, with high prevalences (2.9–9.0%) in some communities in the Sikasso region. The predominant species of STH infection was hookworm, with negligible infection by Ascaris lumbricoides and Trichuris trichiura. Integrated schistosomiasis/STH impact assessments from 2014 to 2017 sampled 5776 children, with an overall prevalence of 0.1% (95% CI 0.1% to 0.3%) and 0% MHI infections. The integrated TAS-STH surveys in 2018–2019 in 29 districts further confirmed an overall low STH prevalence of 0.1% (95% CI 0.0% to 0.3%). These results indicate the progress towards the national goal of eliminating STH as a public health problem in Mali and highlight the need for continued surveillance in certain regions.ConclusionThrough over a decade of integrated treatment overcoming major security challenges, Mali may have successfully eliminated STH as a public health problem in all regions, one of the first countries in Africa to achieve this milestone.

Mali has become increasingly interested in the evaluation of transmission of both Wuchereria bancrofti and Onchocerca volvulus as prevalences of both infections move toward their respective elimination targets. The SD Bioline Onchocerciasis/LF IgG4 Rapid Test was used in 2 evaluation units (EU) to assess its performance as an integrated surveillance tool for elimination of lymphatic filariasis (LF) and onchocerciasis. A cross sectional survey with SD Bioline Onchocerciasis/LF IgG4 Rapid Test was piggy-backed onto a transmission assessment survey (TAS) (using the immunochromatographic card test (ICT) Binax Filariasis Now test for filarial adult circulating antigen (CFA) detection) for LF in Mali among 6-7 year old children in 2016 as part of the TAS in two EUs namely Kadiolo-Kolondieba in the region of Sikasso and Bafoulabe -Kita-Oussoubidiagna-Yelimane in the region of Kayes. In the EU of Kadiolo- Kolondieba, of the 1,625 children tested, the overall prevalence of W. bancrofti CFA was 0.62% (10/1,625) [CI = 0.31-1.09]; while that of IgG4 to Wb123 was 0.19% (3/1,600) [CI = 0.04-0.50]. The number of positives tested with the two tests were statistically comparable (p = 0.09). In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of W. bancrofti CFA was 0% (0/1,700) and that of Wb123 IgG4 antibody was 0.06% (1/1,700), with no statistically significant difference between the two rates (p = 0.99). In the EU of Kadiolo- Kolondieba, the prevalence of Ov16-specific IgG4 was 0.19% (3/1,600) [CI = 0.04-0.50]. All 3 positives were in the previously O. volvulus-hyperendemic district of Kolondieba. In the EU of Bafoulabe-Kita-Oussoubidiagna-Yelimane, an overall prevalence of Ov16-specific IgG4 was 0.18% (3/1,700) [CI = 0.04-0.47]. These 3 Ov16 IgG4 positives were from previously O.volvulus-mesoendemic district of Kita. The SD Bioline Onchocerciasis/LF IgG4 Rapid test appears to be a good tool for integrated exposure measures of LF and onchocerciasis in co-endemic areas.

In 2009, three years after stopping mass treatment with azithromycin, a trachoma impact survey in four health districts in the Kayes region of Mali found a prevalence of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years of >5% and a trachomatous trichiasis (TT) prevalence within the general population (≥1-year-old) of <1%. As a result, the government's national trachoma program expanded trichiasis surgery and related activities required to achieve trachoma elimination. In 2015, to assess progress towards elimination, a follow-up impact survey was conducted in the Kayes, Kéniéba, Nioro and Yélimané health districts. The survey used district level two-stage cluster random sampling methodology with 20 clusters of 30 households in each evaluation unit. Subjects were eligible for examination if they were ≥1 year. TF and TT cases were identified and confirmed by experienced ophthalmologists. In total 14,159 people were enumerated and 11,620 (82%) were examined. TF prevalence (95% confidence interval (CI)) was 0.5% (0.3-1%) in Kayes, 0.8% (0.4-1.7%) in Kéniéba, 0.2% (0-0.9%) in Nioro and 0.3% (0.1-1%) in Yélimané. TT prevalence (95% CI) was 0.04% (0-0.25%) in Kayes, 0.29% (0.11-0.6%) in Kéniéba, 0.04% (0-0.25%) in Nioro and 0.07% (0-0.27%) in Yélimané. Eight years after stopping MDA and intensifying trichiasis surgery outreach campaigns, all four districts reached the TF elimination threshold of <5% and three of four districts reached the TT elimination threshold of <0.1%.

Wuchereria bancrofti (Wb) and Mansonella perstans (Mp) are blood-borne filarial parasites that are endemic in many countries of Africa, including Mali. The geographic distribution of Wb and Mp overlaps considerably with that of malaria, and coinfection is common. Although chronic filarial infection has been shown to alter immune responses to malaria parasites, its effect on clinical and immunologic responses in acute malaria is unknown. To address this question, 31 filaria-positive (FIL+) and 31 filaria-negative (FIL-) children and young adults, matched for age, gender and hemoglobin type, were followed prospectively through a malaria transmission season. Filarial infection was defined by the presence of Wb or Mp microfilariae on calibrated thick smears performed between 10 pm and 2 am and/or by the presence of circulating filarial antigen in serum. Clinical malaria was defined as axillary temperature ≥37.5°C or another symptom or sign compatible with malaria infection plus the presence of asexual malaria parasites on a thick blood smear. Although the incidence of clinical malaria, time to first episode, clinical signs and symptoms, and malaria parasitemia were comparable between the two groups, geometric mean hemoglobin levels were significantly decreased in FIL- subjects at the height of the transmission season compared to FIL+ subjects (11.4 g/dL vs. 12.5 g/dL, p<0.01). Plasma levels of IL-1ra, IP-10 and IL-8 were significantly decreased in FIL+ subjects at the time of presentation with clinical malaria (99, 2145 and 49 pg/ml, respectively as compared to 474, 5522 and 247 pg/ml in FIL- subjects). These data suggest that pre-existent filarial infection attenuates immune responses associated with severe malaria and protects against anemia, but has little effect on susceptibility to or severity of acute malaria infection. The apparent protective effect of filarial infection against anemia is intriguing and warrants further study in a larger cohort.

Background As part of a multi-country evaluation, the SD Biosensor STANDARD Q Filariasis Antigen Test (QFAT) was compared with the Abbott Bioline Filariasis Test Strip (FTS) for assessing Wuchereria bancrofti infection prevalence and for ease of use of QFAT in field conditions in Sierra Leone. Methods and principal findings The evaluation was done in two districts, Bombali and Karene, where repeat pre-transmission assessment surveys (pre-TAS) were planned. Two rural sites, Kagbo and Makorba Yelimini which recorded high LF antigen prevalence of 4.1% and 7.7% respectively in repeat pre-TAS in 2020 were selected for the QFAT evaluation. At least 350 people [greater than or equal to]5 years were targeted per site for inclusion in the study by convenience sampling. Blood was collected by fingerstick; 20[mu]l for QFAT and 75[mu]l for FTS. The reading time for both tests was 10 minutes. For all positive or invalid results, a repeat test was performed for both tests. In total, 728 participants (5-91 years) were tested by QFAT and FTS. Four FTS and three QFAT final results were classified as indeterminate (meaning a positive result followed by a negative result) and were excluded from the analysis. The positive rate was 4.8% (17/357) and 3.5% (13/367) for FTS and 3.4% (12/359) and 4.1% (15/366) for QFAT in Kagbo and Makorba Yelimi, respectively. All participants testing positive for FTS or QFAT underwent further testing by night blood smear to detect microfilariae using microscopy. No W. bancrofti microfilariae was detected in any of the antigen positive cases. In field conditions, QFAT was easy to handle and recorded zero invalid tests compared to FTS (six invalids). The concordance between FTS and QFAT was 0.81 (Cohen's Kappa). The discrepancy found between the two tests in terms of positive tests was not statistically significant (p = 0.78). Conclusions/significance The results suggest that the QFAT is a credible W. bancrofti diagnostic test when compared to the routinely used FTS; use of either test would result in the same program decision.

There is no effective therapy for Mansonella perstans , a cause of lymphatic filariasis. In this study, patients were randomly assigned to receive treatment with doxycycline for 6 weeks, targeting the endosymbiont wolbachia, or no treatment. M. perstans microfilaremia was undetectable at 12 months in 67 of 69 treated patients (97%), as compared with 10 of 63 untreated patients (16%). Patients were randomly assigned to receive treatment with doxycycline for 6 weeks, targeting the endosymbiont wolbachia, or no treatment. M. perstans microfilaremia was undetectable at 12 months in 97% of treated patients, as compared with 16% of untreated patients. The filarial parasite Mansonella perstans is endemic in central and western Africa, with a distribution that overlaps that of Wuchereria bancrofti , Loa loa , and Onchocerca volvulus . Transmitted through the bite of an infected midge (culicoides species), infective M. perstans larvae develop over the course of months into adult worms that reside in the serous cavities and mesentery and retroperitoneal tissues. Microfilariae are carried through the bloodstream, and those of M. perstans can be distinguished from those of L. loa and W. bancrofti by their small size, lack of periodicity, and the absence of a sheath. As is . . .

The National Blindness Prevention Program in Mali has broadcast messages on the radio about trachoma as part of the country's trachoma elimination strategy since 2008. In 2011, a radio impact survey using multi-stage cluster sampling was conducted in the regions of Kayes and Segou to assess radio listening habits, coverage of the broadcasts, community knowledge and behavior specific to trachoma and facial cleanliness of children. Radio access and listening were high, with 60% of respondents having heard a message on the radio about trachoma. The majority of respondents knew about trachoma, its root causes, its impact on health and prevention measures. Additionally, 66% reported washing their children's faces more than or equal to twice/day and 94% reported latrine disposal of feces. A high percentage of persons who gave a positive response to knowledge and behavior questions reported hearing the trachoma messages on the radio with 60% reporting that the radio is where they learned about trachoma. There was no significant difference in facial cleanliness when comparing children whose primary caregiver had/had not heard the trachoma messages. Next steps include revising the current messages to include more focused behavior change messaging and to engage in a more robust use of community radios.